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HomeMy WebLinkAbout0067 SOUTH PRECINCT ROAD - Health 67 South Precinct Road Centerville, MA A= ate/%G � UPC 12534 0.2.153LO 6 e / TOWN OF BARNS/TABLE LOCATION _ 7 �uurG� &cG h c ir' I,� SEWAGE# ?00S VILLAGE ASSESSOR'S MAP&PARCEL /418-l4S- INSTALLERS NAME&PHONE NO. SOO—5'2y-fla y24Se,eWi dg�90,,--v s SEPTIC TANK CAPACITY /O00 LEACHING FACILITY:(type) 2— (size) ?S—X /3 NO. OF BEDROOMS 3 OWNER &1,-1Z' PERMIT DATE: COMPLIANCE DATE: a--0 7 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY /l/ 7ouTli f�fClhC7 OC�� t3�c� 30 e �9. TOWRI OF BARNSTABLE LOCATION G� Sw PreCtn T P� SEWAGE # �IIsLAGE CQ�Tt�r���� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Ow LEACHING FACILITY: (type) P, (xdo (size) 1 NO. OF BEDROOMS 3 BUILDER OR OWNER laR SPECTION1 PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leachig facility) Feet Furnished by -L4J?2Grr''on FD�� GI r B � --- aa� ag 3 TO N OF BARNSTA�BLE _ LOCATION ��SOU; Ct�� Z- p SEWAGE#.-I VILLAGE ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS OWNER Q it PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY J No. T Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Rpprication for Mis pozaf *pztem Conelruction Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.4.c9 Owner's N=e,Address and Tel. o. Assessor's Map/Parcel Z IVS Installer's Name,Address,and Tel.No. 4/00—9'7j 8 Designer's Name,Address and Tel.No. (. 1 F Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design,Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code nd not to pl &yst in operation until a Certifi- cate of Compliance has be d by Board of ItV Sign Q Date — --� Application Approved by Date Application Disapproved for the following reas Permit No.dat2Date Issued I� Now Fee r� . ` .` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y's PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MAS'SACHUSETTS -Applicat on`for Di5po5af *pgtem Construction Vermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No.(or? S• r--q_Q ­-V 7- pwner'sNgne,Address and Tel,Vo. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. �8�''S/:j�=�'',S8 Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number o f sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil i y , v Nature of Repairs or Alterations(Answer when applicable) Date last inspected: A Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code nd not to place the system in operation until a Certifi- cate of Compliance has bee", s,ed by ..s Board of alt ��XA4[ v Signed t x- /,? Date — 3_0 Application Approved by 1f �D �� il1. l,,l` - Date Application Disapproved for the following reas>n Permit No, Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance 1 THIS IS TO CERTIFY, th t the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by 6 T? � �- Q��c. ct , 2V,U 4&_ at [Y�WWJKS hastbeen constructed in accordance with the provisions of Title 5 and th for Disposal Sy tem ons ction Permit No �ated Installer a'� Designer The issuance of this e 't hall t be construed as a guarantee that the sy t m ill func, ction as d�igne Date d 7 Inspector ,4 A r _ l ——————————— ————— - --- _ ..... ,�.�. . No./'? .l � 1�---------------------- Fee ,- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Di!5po.5ar *pztenon5truction Permit Permission is hereby granted to Construct( )Repair( )Upgrade )Abandon( ) System located at C,V`( l Y�. and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to % comply with Title 5 and the following local provisions or special conditions. Provided: Constructio must be Ic m, leted within three years of the date of this p e" rmit? Date: F�� � `/L J Approved b _.. PP y r — Town of Barnstable Regulatory Services . o Thomas F. Geiler,Director : .a,uevsr�asa. 9 RAM g Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Fax: 508-790-6304 Office: 508-862-4644 Installer & Designer Certification Form Date: Designer: ��0,k,v Installer: Address: SULL-� cv ��� �Vt:C Address: J � r was issued a permit to install a On !a�tl�� �.e N ®g (date) (installer) n septic system at L-7 So u '` E C_ , `u� �� based on a design drawn by (address) �Z Q &L G. mac: " dated �cT 1(� 2M (designer) I certify that-the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10 lateral relocation of the SAS or any vertical relocation of any compo nent of the septic system)but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. PS7E.� �GN SULLEVFiN CIVIL taller s Signature) No,29733 (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF CONIPLLANCE WILL NOT BE ISSUED UNTIL BOTH_ THIS FORtiI AND AD- BUILT CARD ARE RECEIVED BY THE BARNST-ABLE PUBLIC HEALTH DIVISION. T13ANK YOU. Q:Health/Septic/Designer Certification Form °F ZHE A y� °�► Town of Barnstable BARNSTABLE� # Regulatory Services MAM. $ 1639. Thomas F. Geiler,Director ABED MA'S A Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 19, 2005 Mr&Mrs Kevin Breau 67 South Precinct Road Centerville,MA 02632 NON-COMPLIANCE WITH STATE ENVIRONMENTAL CODE TITLE V. The septic system owned by you located at 67 South Precinct Road, Centerville, MA eas inspected on May 31st, 2005 by James M. Ford, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) DUE TO THE FOLLOWING: The leaching pit was full. Liquid was up to the cover and breaking out into a hole. You have two years from the date of the system inspection to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. BARNSTABL"HEALT DEPARTMENT COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTEC3pigNIU N 1.3 PM 2:-00 i�P'+ilSz©f� TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 67 South Precinct Road Centerville MA 02632 Owner's Name: Janet&Kevin Breau Owner's Address: Date of Inspection: . Me 31, 2005 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O.Box 49 _ Osteryft MA 02655-0049 Telephone Number: (508)862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority ✓ Fails Inspector's Signature: Date: June 6 2005 The system inspector shall sub 't copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 67 South Precinct Road Centerville, MA Owner: Janet&Kevin Breau Date of Inspection: May 31, 2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 l Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 67 South Precinct Road Centerville, MA Owner: Janet&Kevin Breau Date of Inspection: May 31, 2005 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 h OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 67 South Precinct Road Centerville, MA Owner: Janet&Kevin Breau Date of Inspection: May 31, 2005 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than %2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped—. Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] Yes (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 r Page 5 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 67 South Precinct Road Centerville, MA Owner: Janet&Kevin Breau Date of Inspection: May 31, 2005 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the.previous two weeks? ✓ _ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS,located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 67 South Precinct Road Centerville, MA Owner: Janet&Kevin Breau Date of Inspection: May 31, 2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n1a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped in 2004-per owner(Also pumped after inspection) Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed on 6110181 -per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 67 South Precinct Road Centerville, MA Owner: Janet&Kevin Breau Date of Inspection: May 31, 2005 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron 40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 6" Material of construction: ✓ concrete _metal _fiberglass _polyethylene other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 Qal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: _ Measurine stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert There did not appear to be anv si ns of leakage GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or,baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 67 South Precinct Road Centerville. MA Owner: Janet&Kevin Breau Date of Inspection: Mav 31, 2005 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: _gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: None (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box.is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): L PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 67 South Precinct Road Centerville, MA Owner: Janet&Kevin Breau Date of Inspection: Me 31, 2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: I-6'x 6'(1000 gal.) leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): The leach pit was full. Liauid was un to the cover and breakinje out into the hole The pit was in hvdraulic failure The bottom to Qrade was 7.5'. The cover was 12"below Qrade CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 0 . Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 67 South Precinct Road _ Centerville. MA Owner: Janet&Kevin Breau Date of Inspection: May 31. 2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. I A 13 ;L I rg as C;) -;)a(aag 3 3 3Y yco 10 y Page I 1 of 11 • OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 67 South Precinct Road Centerville, MA Owner: Janet&Kevin Breau Date of Inspection: Me 31, 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 20+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic maps and water contours map the maps were showing approximately 20'+/ to ground water at this site. This report has been prepared and the system inspected and failed as of the date of inspection. This report is not a warranty.or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed,written or implied,relating to the system, the inspection and/or this report. 11 TOWN OF BARNSTABLE LOCATION Sw �reUnC,T_ R� SEWAGE # t' I I O VILLAGE 0�f-CAL ASSESSOR'S MAP,& LOT �°` �"� IL INSTALLER'S NAME&PHONE NO.' SEPTIC TANK CAPACITY aW I LEACHING FACILITY: (type) Pt� �X�o (size) . .� NO, OF BEDROOMS. 3 l BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: 5 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leachiig facility) Feet Furnished by _ilrAG6 tin i a,�Wk J rs as a as a9 Finc._10................ .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH __.ro U444......................0 F... ........................................... Appliration for Uhipoiial Wor�Towitrurfiott Vanfit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ...U--------------------- .......................... .... . ....................... ................. Locat�n-Address Lo tNo. ........ A ... , . ............................... ..... ....... e.. ......0 C.. . . ............... Ovjr Address ................. --- ---------------------------------------------------- ­---------------------------------------*"*"*.........-----------­*.......................... Installer Address Type of Building Size Lot---- .....Sq. feet U Dwelling—No. of Bedrooms__________..................................Expansion Attic Garbage Grinder (Nd P4 Other—Type of Building ............................ No. of persons____________________________ Showers Cafeteria 04 Other fixtures ....................................................................................................................................................... Design Flow_____________Sj 5.......................gallons per person per Py. Total daii pw------33.4....i1e,.................Vilow. WSeptic Tank—Liquid capacityj42,0.(.)...gallons Lengthl_(4....... Width._` ---- ---- Diameterl----6-------- Depth ...... Disposal Trench o..................... Width-_--------------_ Total Length................... Total leaching area....................sq. f t. Seepage No_________-----------. Diameter_____- ____________ Depth below inlet________________. Total leaching area.20D........sq. f t. Z Other Distribution box Dosin tank Percolation Test Results Performed by 1U,.... -,A I.....C..:.:--1....... Date_______________________________________ ,.-I Test Pit No. -----minutes per inch Depth of Test Pit_.... ......... Depth to ground watt Woble__ �T4 Test Pit No. 2..K,�......minutesper inch Depth of Test Pit-------�_2_1..... Depth to ground water.kw_c.�&6ej ............... .......... ..............0-------------------4---- ......... .... .. . ...... --------------- 0 Description of Soil-.- Q-.-?......�: A....................... ...D...M... L 0i_----------------- -----C�_::S_D.... --------- 0 - ---c-------------- -0( ..................... ....... G,1 A --- ......... --------------------...................q----- --- -----IV -------------------------- ....................... ..............V. --------------- U Nature of Repairs or Alterations—qkyMer e 'fow__ _��Cn Mica le.______________________________________ ______---- ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of LIT 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by tl�e board of he lth. ............ .................. . ...... Da. ............... ..... Application Approved By.............. .......... Date Application Disapproved for the following reasons:................................................................................................................ ....................................................................................................................................................................................................... Date PermitNo......................................................... IssuedL....................................................... Date L � _ Y .f - /F�- THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF .... .............OF..... .! ' Ya. ....VEALTH fib.. C---......................................... Appliration for Uiovoii al or�p Tonotrnrtion Frrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at- R )0 , tt � ................ Loc.0 i-Address `S ( Lot No. (� - a.s - ... ! `( .......................t� �.1 _ . C_tt�i G_ t� .................. •----- Owner Address a .........-••••....---._r ' � Installer Address UTvpe of Building Size Lot----; 0.1.Q.....Sq. feet Dwelling—No. of Bedro .............................................................Expansion Attic ( ) Garbage Grinder ( � P4 Other—Type of Building ____________________________ No. of persons............................. Showers ( ) — Cafeteria ( ) a' Other AxtPres ------------------------•--------- Design Flow............. .......................gallons per person pier yiay. Total d�jly qpw----- _ _ _ to W 'p �j/ / T 3'� WSeptic Tank—Liquid capacityjMO...gallons Length.__...�___.._. Width....... ¢___ Diameter________________ Depth._ ...... x Disposal Trench—Tio. .................... Width._-------.------.- Total Length......_________... Total leaching area....................sq. ft. Seepage Pit No-------- Diameter______ ____________ Depth below inlet.... Total leaching area.2,00.......sq. ft. Z Other Distribution box ( ) Dosin nk ( j Percolation Test Results Performed b _ __s----- C� ��&�w 1. _: Date....................................... al Test Pit No. 1.°� .....minutes per inch Depth of Test Pit------ t Depth to ground water_.- �/ .__ Test Pit No. 2_4•�___-_minutes per inch Depth of Test Pit____-__��_...... Depth to ground water.kN_C_0lP#1 �'�Cl O Description of Soil j Ae�J l � i_,s�at a "s a� sM h ­ -- Ai.r x ------------ ---•-•-- W � " ' - '- U Nature of Repairs or Alterations ' An er when app icable. __________________________________ N ..............--....................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of�I;'E, p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of liealth. Sinew ---............... - -.-.� ..._..... ---J....�... � ,,,�' � .. Date Application Approved BY --------------- ' Y.:... r""f% ..............---•- ,,. / , Date Application Disapproved for the following reasons:-------•-.--- ---•----•----------------------------•---------------------------------•......---------•-- ............•---•--•--------•••--•-•---------------------•--------••-•••-••••----._..........------------ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA. .TH G1 ....................OF.....17.A.f`N. .+a. . .�.......................s........•.... Currtifiratr of TompliFanrr THIS IS TO CERTIFY, That t e Individual Sewage Disposal System constructed ( ) or Repaired ( ) by----------------r'`- grr: ....... s -•" '. ._......_.__._... e; I alter j V has been installed in accordance with the provisions of TI H 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No. ?!�__/,/10.................. dated-------------------------------- ---._-------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THEE SYSTEM WILL FUNCTION SATISFACTORY. DATE...............................61��ISI............................. Inspector------. /. ----------•-------------------------•-----•---••------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT >, ........! .!A.................OF.... ±!'.Nt.' .` k_.................................. aifipn� al Vorkg Tono#rnriion Upamit 10, Permission is hereby granted........ 5�....__ to Construct (1, rpr Repair ( ) an Individual Sewage Disposal System f at.No............. . .. ................. �' o. -- �, -C .--r'-.11..------�-�---, ..................... .......--•---------------- --- Street as shown on the application for Disposal Works Construction Permit No--------------------- Dated.......................................... BoaY� of Health DATE................... /•------------------•---•--•------••- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS y Z- LO CATION SEWAGE PERMIT N0. .6 7 py-e c C71 VILLAGE INSTA LLER'S NAME i ADDRESS A c, t UILDE R OR OWNER 1 -e DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED rho 4 S k &�% e 2 eA R, Air f l465 - _ 43 i ' _ � ,�Y ri I \4_4.0`h 41.1 Existin Septic a 43.75 g rl --\ - 'opEI 42-1 — O anx43.5 C f R A _ 3 3 5 4 3.18-- —. } - I I T ; s '� Rol FI 3.3- 1 LOCUS = a> �I N t-- 4 _ o Bedding as �Existing 6 �`\✓�/ \� / �� pRE --' D-Box T.H. I Adjusted Ground _ TR Per Titie 5 Water Elev. 32.7 S DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Not toSc.ole NOT=S y, DESIGN DATA LOCUS PLAN _77, I;' r6" '� '. - SupP!y For Th,s I_ot is Municipal Water. Single Family- 3 Bedroom 2 L on of Utilities Shown on This Plan Are Approx, No Garbage Grinder Scale I fr= 2000�± �e•^_st 72 Hours Prior to An Excavation For This Project Ma Daily Flow: 110x 3 = 330 gpd Assessors Map 148 ~`. oic The Contractor Shall Make The - qwired Septic Tank: 330 gpd x 200%=F60grd u4,3Y Notlficaticnto DIG SAFE- i-888-344-7233. Use Existing Septic Tank. ParCel145 3.The Contractor is Required to Secure Appropriate LEACHING AREA Groundwater Overlay F<'S Agencies o Construction District: WP Pe,,mf is From Town Age es For Ce.`mad by This Plan. - d 330 gpd/ - 44 s f. quire 0.74 6 Re 4 Irsiall Risers as Re uired to Within 12"of Finished Sidewalli 2(1.2 + 25 )2= 148 s.f. Gr a q Bottom Area: 12�x 25'=300 s.f. 448 s.f.Total Provided. 5.all Structures Buried Four Feet (4') or More or Sui:ject taVehicular robe i-20 Loading. LEACHING CHAMBER DESIGN t a _ — o.Se ,tic System to be Install d i n Ac cord a rice y h All Pipes to be Schedule 110 PVC. Use 2 31 CMR 15.00 Latest Revision And The Town of - 500 Gallon Leaching Chambers in a 5a:nstaaie Board of Health Regulations. 12'x 25r Washed Stone Field as Shown. -1 �?:a tJun.lnaz> 7 A!! Piping tobe Sch. 40 PVC 8.Des,tn of inlet Tee Below Flow Line I0"Min. �.. .....- 7 0. Dei th of Outlet Tee Below Flow Line,l4• Min. Wi t+. Gas Baffle. PLAN VIEW Fimh Scale 1 f�= 401 ` r: r,irer Groundwater Adjustment ..___...._..._„_—_.,....._..__. a'. rubric Groundwater at Elev. 29.9 ' Index Well t SDW 252 Zone C PC0$'° Adjustment: 2.8T, April 1980 - - I Leachfag Adjusted Groundwater Elev.32.7 L Chamber 3/4'-11/2"Uoubb Washed s � - �a CROSS SECTION OF CHAMBER .27� ': t .!� NOT TO SCALE CIVIL ar•.- C, s � i J CD f -z. QSITE PLAN SEPTIC SYSTEM UPGRADE JA•NET REIDY 67 SOUTH PRECINCT ROAD CENTERVILLE , MASS. r SCALE*AS.SHOWN DATE- AUG.16 ,2005 I SULLIVAN ENGINEERING INC. } OSTERVILLE,, MASS. �t e� F G 4 6.5 F.G. 43.1 v 1 -- Y.-, D ' 44.0 41.1 i Existing Septic — _ Top El 42.1 43.75 Tank ,43.5 .0 a J B o l El 39. 1 R� _ 43.35 ( 43.18 LOCUS `✓/ `� ��✓ Bedding as Existing T.H. I Adjusted Ground ,� � / ��. �''/ '>•' PRI�r� E� Per Titie S D-Box lam. Water Elev. 32.7 c SD DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM %� - t ✓� r Not to Srale j `� - ji b Q 0 NOT_S .ae+ 0R DESIGN DATA i, zr Supply For This LotiS Municipal Water. LOCUS PLAN— Single Family- 3 Bedroom 2. tion of Utilities Shown on This Plan Are Approx. No Garbage Grinder g Scale - I r� 20.00'- w� \� . yeast 72 Hours Prior to Any Excavation For This Daily Flow: 110 x 3 = 33C gpd Project The Contractor Shall Make The Required Septic Tank 330 gpd xzoo°i°-s�o�pd Assessors Map 148 Notification to DI G SAFE- 1-888-344-7233. Use Existing Septic Tank. Parcel145 3.The Contractor is Re uired to Secure Appropriate \ 5� p q LEACHING AREA Groundwater Overlay ermi,s From Town Agencies For Construction Deemed by This Plan. 330 gpd/0.74= 446 s f. Required District: WP � 4.lr,stali Risers as Required to Within 12"e,r Finished Sidewall: 2(12 + 25 )2 = 148 s.f. ,.� x 4,5,H r� ? 1 *\e, '` Gr:de. Bottom Area: 12'x 25'=300 s.f. � 5.4II Structures Buried Four Feet (4') or More or 448 s.f.Total Provided. Sur.lect to VehiculartcbeH-2C Loading. LEACHING CHAMBER DESIGN 6.Se etc System tc be Installed in Accordance With All Pipes to be Schedule 40 PVC. Use 2 a`T-- —�` 31c CMR 15.00 Latest Revision And The Town of - 500 Gallon Leaching Chambers in a \. tip• ^ ''._.—� '1` °i® 2 ._._._> _._ _... - k�xls<, Lc�c:1 n 1 z- -ToBa;nstabie Board of Health Regulations. 12'x 25'Washed Stone Field as Shown. — p �=, 7. All Pining lobe Sch. 40 PVC 8.De:.thof inlet Tee Below Flow Line: 10"Min. De,Th of Outlet Tee Below Flow tine 14"Min. 1hi �. Gas Baffle. PLAN VIEW Finish Scale: I "= 40' Grade .fir: F�I�er •_ � 1.� Groundwater Adjustment rabric Compacted Fitt ---- ,',F." 0,1_ Groundwater at Elev. 29.9 Index Well: SDW 252 Zone C Kr<<Yv<fr Pea Stone ' - - Adjustments 2.8 , April 1980 Leaching Adjusted Groundwater Elev.32.7 ChamLer -3r4"-t l/z"uaafd. I P.n=*•a"L:hh w.0A-r-k55. Su,F1 U ,7{ . ,v.�jt} washed OF Z4,g PETER CROSS SECTION OF CHAMBER $ULUV/?s-t - CO.2973� „s __ -...-...-,..�_ ___�_.....-.-____";±_s•L -�� NOT TO SCALE CIVIL f CD `ati�L�11.uT\n GOc„RSc =ANp l c,l!i r= w•-�1?= S?.Alp t-j c� GG,Otihl� �,s,/nTGs� SITE PLAN v' c�Qo�.•`L- zaV'o'er CcRr'' SEPTIC SYSTEM UPGRADE w';-�:_ss •. ?.i,�i� lr�uRl�Ay, -rO,f3. ' JANET REIDY f 67 SOUTH PRECINCT ROAD CENTERVI LLE , MASS. SCALE:AS SHOWN DATE: AUG.16 ,2005 SULLIVAN ENGINEERING INC. OSTERVILLE, MASS. i - . eV, " _ - P\ - - ,� I jiA- i, ,i e r'j /_-.", / . )- .s2.� ' r 4'-l2 '/'t�JEis/U>-t t v,0.4l_s& . m � 0-6 - � Le-cv. ,?9.9 U v . L ` 4_4.>p s' /' • ,45•,a - - 1;,65 . 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